Spravato® Treatment in New York City: What to Expect and Who It's For

For individuals living with depression that hasn't responded to standard treatments, the search for relief can feel exhausting and demoralizing. You may have tried multiple antidepressants, adjusted doses, added therapy, changed therapists — and still feel like you're not getting where you need to be. If this sounds familiar, you're not alone. And there are options beyond what you may have already tried.

Spravato® (esketamine) is an FDA-approved treatment that works differently from traditional antidepressants and has shown meaningful results for people with treatment-resistant depression. This article explains what it is, who it's designed for, what treatment sessions actually involve, and how to access it in New York.

What Is Spravato®?

Spravato® is the brand name for esketamine, a derivative of ketamine that is FDA-approved as a nasal spray for two specific conditions:

• Treatment-resistant depression (TRD) — major depressive disorder that has not adequately improved after trying at least two different antidepressants at appropriate doses and durations

• Major depressive disorder with acute suicidal ideation or behavior (MDSI)

It is important to understand that Spravato® is not a first-line treatment and is not used in place of traditional antidepressants. It is used when standard approaches — antidepressants, therapy, or both — have not provided sufficient relief. It is always used alongside an oral antidepressant as part of a broader treatment plan.

How Spravato® Works Differently

Most standard antidepressants — SSRIs like sertraline or escitalopram, and SNRIs like duloxetine or venlafaxine — work primarily on the serotonin or norepinephrine systems. They take weeks to build up in the system and produce therapeutic effects.

Esketamine works on the glutamate system, specifically targeting NMDA receptors. Glutamate is the brain's most abundant excitatory neurotransmitter and plays a significant role in mood regulation, neuroplasticity, and the brain's ability to form new connections. By targeting this pathway, Spravato® works through a mechanism entirely different from standard antidepressants — which is one reason it can produce results in people who haven't responded to multiple prior medications.

Some patients notice symptom reduction within hours to days of their first session, which is markedly faster than the four-to-eight-week onset typical of oral antidepressants.

Who Is a Candidate for Spravato®?

Spravato® may be appropriate if:

• You have been diagnosed with major depressive disorder

• You have tried at least two antidepressants — at adequate doses and for adequate durations — without sufficient improvement

• You have undergone a comprehensive psychiatric evaluation and been determined to be clinically appropriate

• You do not have contraindications such an active substance use disorder, certain cardiovascular conditions, or other factors your provider will screen for

Candidacy is determined through a thorough evaluation process — not a checklist. A psychiatrist will review your full treatment history, current medications, medical background, and symptom pattern before recommending Spravato®.

It is not appropriate for everyone, and a careful evaluation is both required and important.

What a Treatment Session Involves

Because esketamine can cause dissociation and temporary changes in perception, it cannot be taken at home. Every session takes place in a certified clinical setting under direct medical supervision.

A typical session looks like this:

• You arrive at the clinic and are assessed before treatment begins

• You administer the nasal spray yourself under clinical supervision

• You remain in the office for approximately two hours while staff monitors for side effects including blood pressure changes, dizziness, dissociation, or nausea

• Before you leave, you are assessed to confirm you are stable

• You should not drive yourself home — transportation must be arranged in advance

The treatment schedule follows a structured protocol. During the induction phase — typically the first four weeks — sessions are scheduled twice per week. This moves to weekly during the optimization phase, then every one to two weeks during maintenance, depending on individual response.

What Results Can Look Like

Response to Spravato® varies by individual. Some patients experience rapid and significant symptom reduction. Others see gradual improvement over multiple sessions. Some do not respond and may need to explore alternative approaches.

It is not a cure, and it is not permanent without maintenance treatment. But for individuals who have struggled for months or years with inadequate response to standard care, it can represent a meaningful turning point.

Clinical trials leading to FDA approval showed statistically significant reductions in depression severity compared to placebo, particularly in the treatment-resistant population.

Insurance and Coverage

Spravato® is often covered by insurance when eligibility criteria are met — specifically, documentation that at least two antidepressants have been tried without adequate response. Prior authorization is typically required, and the process can be involved. A knowledgeable clinical team can assist with this documentation and authorization process.

Out-of-pocket costs without insurance can be substantial, so confirming coverage in advance is important. Janssen, the manufacturer, also has a patient assistance program for those who qualify.

Finding Spravato® Treatment in New York

Spravato® must be dispensed and administered at a certified treatment site registered with the FDA's REMS (Risk Evaluation and Mitigation Strategy) program. Not every psychiatric practice offers it. When evaluating providers in New York, confirm:

• The practice is a certified Spravato® treatment site

• A psychiatrist will conduct a comprehensive evaluation before treatment begins

• Ongoing monitoring and psychiatric follow-up are integrated into the plan

• The team has experience managing the full treatment course, not just the initial sessions

At Aurora Wellness, we offer Spravato® treatment at our Brooklyn and White Plains locations and accept insurance. All treatment is preceded by thorough psychiatric evaluation, and patients receive coordinated follow-up care throughout the treatment process. We also offer telehealth psychiatric services throughout New York State for ongoing medication management and therapy between in-person sessions.

If you've been struggling with depression that hasn't improved with standard treatments, a consultation to discuss whether Spravato® is appropriate for you is a reasonable and worthwhile next step.